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t <br /> I ,. CL, S,f.• <br /> SIGNATURES <br /> CITY OF l..[A..+G.S PLANNING OFFICIAL: <br /> t rater- <br /> (Print Name) PLANNING FICIAL(Signature) <br /> ! Lbt 5orbIn Ave_ VJ 51)3 -8q1- �7 <br /> DA E AIGRES_S� ` be. ci7sci _ TELEPHONE# <br /> *COUNTY PLANNING OFFICIAL <br /> (Print Name) PLANNING OFFICIAL(Signature) <br /> DATE ADDRESS TELEPHONE# <br /> *If necessary,depending upon city/county agreement on jurisdiction outside city limits but within UGB. <br /> G:\FORMS\SEPTIC\Application Packets\S-39 LUCS.doc MC:S-39 rev: 8/10,04/12 <br />